Pandit Anuja, Singh Vishwajeet, Bharati Sachidanand J, Mishra Seema, Deo Suryanarayana Vs, Bhatnagar Sushma
Department of Onco-Anaesthesia and Palliative Medicine, National Cancer Institute, All India Institute of Medical Sciences, New Delhi, India.
Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India.
Indian J Anaesth. 2020 Aug;64(8):688-695. doi: 10.4103/ija.IJA_34_20. Epub 2020 Jul 31.
Cytoreduction and hyperthermic intraperitoneal chemotherapy (CRS+HIPEC) cause numerous pathophysiological changes. The objective of this study was to compare the effect of two anaesthetic techniques on haemodynamic changes, inflammatory and coagulation parameters during this procedure.
Twenty-one consenting adults undergoing CRS+HIPEC procedure, were block randomised to receive desflurane (V, = 9) or TIVA (T, = 12). After epidural catheter placement and intravenous induction of anaesthesia in both groups with fentanyl, propofol and rocuronium, anaesthesia was maintained with propofol or with desflurane, based on group allocation. Haemodynamic and temperature changes were assessed intra-operatively and variance was analysed. Inflammatory and coagulation markers were measured and compared at five time-points in the peri-operative period. Categorical variables were analysed using Chi square or Fisher exact test. Continuous variables were compared using -test or Wilcoxon rank sum test.
Changes in core body temperature and haemodynamic variables during the hyperthermic intraperitoneal chemotherapy (HIPEC) phase were comparable between the two groups; except mean variance of mean arterial pressure, which was significantly higher ( = 0.0056) in group V (receiving desflurane) (58.98 ± 36.74) than TIVA group (27.51 ± 14.22). Inflammatory markers in both groups were comparable at five defined time points in the peri-operative period. On post-hoc analysis, pairwise comparisons with baseline, between levels of inflammatory markers within each group showed increased post-operative inflammation in group V. Mean prothrombin time was comparable.
Desflurane group suffered greater mean arterial pressure (MAP) instability during the HIPEC phase. Inflammation in both groups was highest during the first 24 h after surgery. Prolonged inflammation was noted in patients receiving desflurane.
肿瘤细胞减灭术及腹腔热灌注化疗（CRS+HIPEC）会引发众多病理生理变化。本研究的目的是比较两种麻醉技术在此手术过程中对血流动力学变化、炎症及凝血参数的影响。
21名同意参与的成年患者接受CRS+HIPEC手术，被区组随机分为接受地氟醚组（V组，n = 9）或全凭静脉麻醉组（T组，n = 12）。两组均在硬膜外导管置入及静脉注射芬太尼、丙泊酚和罗库溴铵诱导麻醉后，根据分组情况分别用丙泊酚或地氟醚维持麻醉。术中评估血流动力学和体温变化并分析方差。在围手术期的五个时间点测量并比较炎症和凝血标志物。分类变量采用卡方检验或Fisher精确检验进行分析。连续变量采用t检验或Wilcoxon秩和检验进行比较。
两组在腹腔热灌注化疗（HIPEC）阶段的核心体温和血流动力学变量变化相当；除平均动脉压的平均方差外，V组（接受地氟醚）的平均动脉压平均方差（58.98±36.74）显著高于全凭静脉麻醉组（27.51±14.22）（P = 0.0056）。两组在围手术期的五个既定时间点的炎症标志物相当。事后分析显示，每组内炎症标志物水平与基线进行两两比较时，V组术后炎症增加。凝血酶原时间均值相当。
地氟醚组在HIPEC阶段平均动脉压（MAP）不稳定情况更严重。两组炎症在术后最初24小时内最高。接受地氟醚的患者出现炎症持续时间延长。
